Mary Moe Trites, MD
Individual provider Active NPI Family Medicine Physician · Spring Park, MN
NPI 1912906017 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1912906017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 29003 (MN)
- Practice address
- 4695 Shoreline Dr
Spring Park, MN 55384-9715 - Phone
- (952) 442-7890
- Fax
- (952) 442-7893
- NPI assigned
- Jul 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 1983
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3501 Douglas N Dr
Crystal, MN 55422-2480
Hospital & facility affiliations
- United Hospital District
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040506000258 | MN | Practitioner - Family Practice | 9234127275 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29003 | MN | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Hospital District Inc. | Family Medicine | Current |
Accepting new patients |
| Carlson Chiropractic Health and Healing Inc. | Past |
Accepting new patients | |
| Infinite Health Collaborative, PA | Past | Accepting new patients | |
| Multicare Associates of the Twin Cities,PA | Family Medicine | Past | Accepting new patients |
Locations
515 S Moore St
Blue Earth, MN 56013
Phone (507) 526-3273
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29003 | MN | Yes |
Addresses
Primary practice location
4695 Shoreline Dr
Spring Park, MN 55384-9715
Mailing address
4695 Shoreline Dr
Spring Park, MN 55384-9715
Phone (952) 442-7890
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113080300 | Medicaid | MN |
Other providers in Spring Park, MN
- SP Services
- SP Services
- Thomas G Stocks
- TCM Wellness Clinic
- Kelly Jean Tibbetts
- Aaron Tsay
- Urology Associates, LTD.
- Dantel Weaver
- Benedict J Weinbeck III
- Kevin M White
All providers in Spring Park, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.